ARN - Registered Nurse Utilization Review Coordinator

ARN - Registered Nurse Utilization Review Coordinator

Erwin, NC $72,009 - $93,099 a year

Full Time

Overview:

Join a dynamic healthcare team as a Registered Nurse specializing in Utilization Review Coordination. This full-time, daytime role involves evaluating patient admissions and observation statuses from the emergency department to ensure appropriate care levels and compliance with medical necessity standards.

Key Responsibilities:

Conduct initial utilization reviews for patients admitted or placed on observation from the emergency department. Collaborate directly with emergency physicians, hospitalists, and private physicians to determine admission necessity. Review direct admissions and planned surgeries to confirm proper status orders. Maintain adherence to evolving regulations impacting utilization management. Work closely with social workers and interdisciplinary teams to promote clinical guidelines and achieve optimal treatment outcomes. Facilitate coordinated care delivery across the continuum, aiming to reduce unnecessary hospital admissions. Perform readmission assessments for patients with recent hospitalizations to develop proactive plans preventing further admissions. Conduct discharge planning assessments to identify and address barriers to transitioning patients to the next level of care.

Education and Certification:

Registered Nurse licensure is required. Certification in Case Management (CCM or ACM) is preferred.

Experience:

Ideally, candidates will have three to five years of acute care nursing experience, with a background in medical/surgical or ICU settings. Experience in case management and managed care claims or reimbursement is advantageous.

Skills and Qualifications:

Strong clinical knowledge and understanding of nursing principles, clinical processes, and interventions. Excellent interpersonal, communication, and negotiation skills, with the ability to engage effectively across diverse social and cultural backgrounds. Self-motivated with proven written, telephonic, and electronic communication abilities. Exceptional organizational and time management skills to prioritize multiple tasks efficiently. Familiarity with third-party payor requirements, managed care, reimbursement, and utilization management. Proficiency in various computer programs including Microsoft Office and healthcare-specific software. Demonstrated ability to build credible relationships with physician leadership and internal/external customers. Adaptable, open-minded, and a positive change agent who fosters teamwork and respect.

Physical Requirements:

Some light lifting and carrying may be necessary. Occasional walking to access different areas of the medical facility. Extended periods of sitting for data entry tasks. Near visual acuity for proofreading and manual dexterity for telephone and computer use.